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At least 811 records · Page 45Linked to original sources
PubMed1997

[Definition and evaluation of a documentation standard for intensive care medicine: the ASDI(Working Group for Standardization of a documentation system for Intensive care medicine) pilot project].

OBJECTIVES: A comparison of data from different intensive care units (ICUs) needs standardized documentation. In this study the ASDI documentation standard for intensive care was tested in clinical practice. Goal of the study was to evaluate parameters and functionality required for a national, interdisciplinary documentation system for intensive care. DESIGN: 13 ICUs participated in a 4-week trial using the provided program for documentation of all admitted patients during the observation period. In addition, a questionnaire was distributed to the unit coordinators. RESULTS: 376 patients were documented in 1591 patient days. Valid SAPS II scores were found in only 29% of the discharged patients (39.1 +/- 15.5 points). Time needed for data entry exceeded preset limits (ten minutes per patient and day) in 38% of the cases. All participants affirmed the necessity of a documentation standard for intensive care, giving quality control and cost analysis as the most important reasons. CONCLUSION: The ASDI data set fitted existing needs very closely. Only 7 out of 122 parameters (5.7%) were found to be superfluous and thus removed. Measures to reduce documentation effort to the default limits were a) a new, date orientated concept for manual recording, b) rede-sign of the user interface with new, user friendly data entry possibilities, and c) the integration of statistical analysis and reports in the documentation system. The revised data set represents a broad-based consensus, which seems to be well-suited as foundation for the national quality assurance program.

Adolescent↗
PubMed1994

Changes in magnetic resonance images of muscle depend on exercise intensity and duration, not work.

Echo-planar magnetic resonance imaging was used to study the effect of exercise rate and duration on magnetic resonance imaging signal intensity (SI) of anterior tibialis muscle in normal human subjects (mean age 35 yr, n = 6). Axial midcalf echo-planar images (repetition time/echo time = 6,000/45, acquisition time = 80 ms) were acquired every 6 s for 1 min before and during 15 min of dynamic ankle dorsiflexion exercise (peak force 36% of 1 repetition maximum) at 10, 20, and 30 contractions/min. At each rate, muscle SI rose along an approximately exponential time course (mean time constant 1.8 min) toward a plateau that was linearly dependent on force times contraction rate (r = 0.64, P < 0.01) but varied significantly among subjects. The results confirm previous reports that changes in muscle SI correlate with exercise intensity, but not with total work performed, over a submaximal range of exercise intensities.

Adult↗
PubMed1998

Quantitative biomechanical analysis of wrist motion in bone-trimming jobs in the meat packing industry.

This study was motivated by the serious impact that cumulative trauma disorders (CTDs) of the upper extremities have on the meat packing industry. To date, no quantitative data have been gathered on the kinematics of hand and wrist motion required in bone-trimming jobs in the red-meat packing industry and how these motions are related to the risk of CTDs. The wrist motion of bone-trimming workers from a medium-sized plant was measured, and the kinematic data were compared to manufacturing industry's preliminary wrist motion benchmarks from industrial workers who performed hand-intensive, repetitive work in jobs that were of low and high risk of hand/wrist CTDs. Results of this comparison show that numerous wrist motion variables in both the left and right hands of bone-trimming workers are in the high-risk category. This quantitative analysis provides biomechanical support for the high incidence of CTDs in the meat packing industry. The research reported in this paper established a preliminary database of wrist and hand kinematics required in bone-trimming jobs in the red-meat packing industry. This kinematic database could augment the industry's efforts to reduce the severity and cost of CTDs. Ergonomics practitioners in the industry could use the kinematic methods employed in this research to assess the CTD risk of jobs that require repetitious, hand-intensive work.

Biomechanical Phenomena↗
PubMed2004

Work performance and pain intensity during exercise. A before-and-after study of a cognitive-behavioural treatment in primary care of young immigrant patients.

PURPOSE: To explore the efficacy of an exercise programme (EP) in primary care on work performance and pain intensity in young immigrants having pain. SUBJECTS: Patients on long-term sick leave, aged 20-45 years, categorized by sex and 'high education' (>/=8 years) or 'little education' (0-7 years). METHODS: The 4-week EP was combined to weekly, patient-doctor, dialogue sessions about pain. Two doctors established the clinical status, explored attitudes to exercise and stationary pain behaviour. The EP included daily sessions of an all-round training (15 exercises on five devices in three rounds) led by a physiotherapist, who neglected dysfunctional behaviours. The target for the training was a good work performance (1.5 points), consisting of endurance during a session (0=one round, 1=two rounds, 2=three rounds) and work behaviour (0=bad, 1=acceptable, 2=good), as well as reduced pain intensity measured on a visual analogue scale. Non-parametric statistics were used to detect significant differences between the before-and-after values. RESULTS: Forty-four men and 73 women, median education 7 years, participated. Nearly all were immigrants. All had muscular pain; 72% were anxious about the pain and 14% were depressed. At the start, nearly all were negative about exercise but participated anyway and significantly improved their work performance (p<0.001) from very low starting values (in median 0.0). Only the highly educated men reached the target levels. The highly educated persons reported less pain, while some men and women with little education reported more pain. The doctors also noted a significant decline in stationary pain behaviour in all sub-groups. CONCLUSIONS: A good efficacy regarding work performance and pain intensity was seen only in the highly educated group.

Adult↗
PubMed1997

Detection of intra- and cross-cultural non-equivalence by simple methods in cross-cultural research: evidence from a study of eating attitudes in Nigeria and Britain.

The desiderata for cross-cultural research are reviewed showing how this is dominated by the presumption of transcultural equivalence hidden by the technical problems of translation. This model requires intensive translation work on measures to preserve "equivalence". This work can be prohibitively intensive, might lead to spurious evidence of "equivalence" and has not produced much evidence of equivalence to date. A psychometric axiom--that a measure with low reliability cannot have validity--suggests a pragmatic way to explore these issues and current statistical software and personal computers make this feasible. We recommend that all cross-cultural research should present the internal reliability of the data as this will expose all but one theoretical problem in the detection of "equivalence". We also suggest that non-equivalence may indicate cross-cultural differences in the dimensionality of eating and body image concerns rather than just a problem to be exorcised by more translation work or to be hidden by not reporting reliability. These issues are not specific to work across languages but also apply to comparisons between any social groups within cultures. This is shown using data from questionnaires in their original English with respondents who were fluent in that language.

Adult↗
PubMed2004

Biological and physiological knowledge and skills of graduating Finnish nursing students to practice in intensive care.

This study describes the basic biological and physiological knowledge and skills of graduating nurse students in Finland against the requirement of their being able to practice safely and effectively in intensive care. The study describes also their interest and willingness to work in intensive care. Measurements were based on the Basic Knowledge Assessment Tool (BKAT-5) developed by Toth in the United States. The sample consisted of 130 nursing students graduating in December 2001 and January 2002. The data were analysed statistically. The students were most knowledgeable in the areas of appropriate precautions, living will and medical calculation, followed by neurology and endocrinology. Scores were poorest for pulmonary, gastrointestinal and cardiovascular knowledge. Intensive care studies and the desire to work in intensive care correlated significantly with the respondents' basic intensive care knowledge. It is important for nursing education to concentrate on developing those areas of intensive care studies where the performance of students is weakest.

Adult↗
PubMed1978

[Training on nursing personnel for work in recovery and intensive care units (author's transl)].

After prolonged deliberations guide lines have now been agreed upon regarding the training and examination of nursing personnel for work in recovery and intensive care units. The recommendations, as adopted by the German Hospital Association 16th November 1976, cannot be accepted unreservedly. One of the main objections is that the proposed course of training would lead to excessive specialization at too early a stage. The aim should be to provide training of an interdisciplinary character, including anaesthesia.

Anesthesiology↗
PubMed1996

Stress and work relationships in the neonatal intensive care unit: are they worse than in the wards?

OBJECTIVE: To compare working conditions, sources of stress and professional relationships between a group of nurses working in neonatal intensive care units (ICU) and those working in general paediatric teaching hospital wards. METHODOLOGY: Surveys were sent to 96 nurses working in general paediatric wards in three Sydney paediatric teaching hospital centres and to 291 nurses working in six major neonatal ICU in Sydney. The survey asked about work environment, patient care, decision-making, sources of stress and professional relationships. Thirty-one questions were identical in each survey. The survey also included the General Health Questionnaire (GHQ) as a measure of emotional health. RESULTS: The response rate was ward nurses 86% and neonatal intensive care nurses 66%. Of the 31 identical statements, nine were significantly different between the two groups. Neonatal nurses were more likely to feel that their ward work areas were overcrowded and poorly laid out with little patient-free space. They had more concerns about inadequate staffing and conflict between nurses and doctors. The general ward nurses were more likely to feel that adequate priority was given to patient pain relief and that they had more influence in such decisions but experienced more stress in keeping up to date and were more likely to feel that communication problems between doctors and nurses were a major source of conflict. Forty per cent of general ward nurses and 32% of neonatal nurses had GHQ scores indicating possible psychological impairment, a significantly higher proportion than would be expected in the population. CONCLUSIONS: Paediatric nurses perceive a variety of stresses in their work, with problems in communication between doctors and nurses being a prominent perception. The high GHQ scores may be a reflection of some of those problems. Attention to problems of under-staffing, better work environment and improved communication may help resolve some of these issues and may have implications for improving patient care.

Humans↗
PubMed1999

Integrating Substance Abuse Content into Social Work Courses: Effects of Intensive Faculty Training.

An evaluation was conducted in a graduate school of social work to assess the integration of substance abuse content into basic and advanced courses by instructors with and without specialized substance abuse training. Students in these courses completed questionnaires that asked about the amount, type, and usefulness of substance abuse content presented during the semester. Instructors with and without specialized substance abuse training completed questionnaires that examined their perceptions of the amount, type, and usefulness of the substance abuse content they had taught. Results showed that (1) faculty with specialized substance abuse training were more likely than faculty without such training to integrate substance abuse content; (2) courses taught by trained faculty received higher ratings from students on the quality of the content; (3) both groups of faculty (trained and untrained) perceived that more substance abuse content had been taught than their students perceived; and (4) neither faculty nor students perceived that too much substance abuse content had been taught. This approach could be useful to social work programs and other disciplines interested in measuring the effects of changes in course content.

Journal Article↗
PubMedDate not supplied

"Thinking upstream" to evaluate and to improve the daily work of the newborn intensive care unit.

One may divide patient care problem-solving approaches into two categories: (1) "Ready, aim, fire" and (2) "Ready, fire, aim." The present paper invites the reader to think about these distinctions and to identify which of these categories might apply to the reader's daily work experience. Espousing the first of these categories, and anchored in the notions of systems thinking, this paper offers the reader a framework to better understand and implement the daily work of the newborn intensive care unit. This knowledge and competence may be achieved by "thinking upstream," connecting "downstream" outcomes with "upstream" work process steps. The central elements that govern and inform the process of "thinking upstream" are articulated here in actionable terms.

Humans↗
PubMed1986

Effect of work load on free and sulfate-conjugated plasma catecholamines, prolactin, and cortisol.

The effects of maximal performance capacity and different work load intensities on the response of free and sulfate-conjugated plasma catecholamines, prolactin (PRL), and cortisol were studied in six healthy male volunteers. In a first experiment, the volunteers had to perform a step-wise incremental bicycle ergometer test to determine the onset of blood lactate accumulation (OBLA) and aerobic capacity (VO2 max). The levels of free noradrenaline (NE), adrenaline (Epi), and dopamine (DA) increased considerably, whereas no significant changes for sulfate-conjugated catecholamines, PRL, and cortisol were observed. In a second series of experiments with the same volunteers, the effects of 30 min exercise were studied at a constant work load intensity on 3 different days. Three intensities were used for each of the volunteers: 45%, 60%, and 75% of their aerobic capacity (i.e., below, close to, and above their OBLA). The values obtained for all parameters showed an intensity-dependent rise. The most important changes occurred at work load intensities above the OBLA. At the highest intensity, all parameters except sulfate-conjugated Ne and cortisol showed a significant increase. Although the physiologic parameters reached a steady state during exercise, there were no indications that this was the case with the values of the neuroendocrine parameters. Ten minutes after the exercise, the levels of the free catecholamines had declined considerably, whereas the values of the other parameters were unchanged or showed a further increase.

Adult↗
PubMed1989

Exercise performance following intense, short-term ventilatory work.

Evidence exists to indicate that prolonged ventilatory work fatigues respiratory muscles and may limit exercise tolerance. However, the effects of short-duration, high-intensity ventilatory work on subsequent exercise remains in question. We tested the hypothesis that intense short-term volitional hyperpnea would result in respiratory muscle fatigue and would therefore hinder subsequent exercise tolerance. Pulmonary function was determined in ten healthy, male subjects before and after two constant load exercise tests to exhaustion on a cycle ergometer. Test 1 was a preliminary test to determine VO2max, peak exercise VE, and peak exercise power output. Test 2 was a constant load (85% peak power output) exercise test to exhaustion. Test 3 was identical to test 2 but was preceded by 10 min of volitional, isocapnic hyperpnea (85% of peak exercise V.E) at a controlled frequency and tidal volume. Pulmonary function measures (FVC, FEV1, FEV1/FVC, and peak flow) were not significantly (P less than 0.05) altered by the volitional hyperpnea. Ventilation and gas exchange variables (VO2, VE, f, end-tidal PO2 and PCO2, VE/VO2, VE/VCO2, %SaO2) during exercise and time to exhaustion were not significantly (P less than 0.05) different between treatments. These experiments failed to show any effect of short-term ventilatory work on pulmonary function or subsequent exercise performance.

Adult↗
PubMed1998

Flow cytometric quantitation of immunofluorescence intensity: problems and perspectives. European Working Group on Clinical Cell Analysis.

Quantitation of immunofluorescence intensity serves to estimate the number of defined molecules expressed on or in cells. Clinical applications of this diagnostic tool are increasing, e.g., aberrant expression of various antigens (Ag) by leukemic blasts or lymphoma cells, intensity of CD38 expression by CD8+ T-lymphocytes to monitor activation status, and intensity of CD62P to detect platelet activation. In this report we discuss the quality-control measures required for quantitation of fluorescence intensity, and we review seven concepts that have been developed to quantify fluorescence intensity during the past 15 years. Initial work addressed the conversion of logarithmic channel numbers into units of relative fluorescence. The design and use of calibration beads labeled with predefined amounts of dye allowed instrument-independent expression of fluorescence intensity in units of molecules of equivalent soluble fluorochrome (MESF). This method was refined by the combined use of such standards with monoclonal antibodies (mAb) conjugated 1:1 with phycoerythrin (PE), allowing translation of fluorescence intensity into numbers of antibodies bound per cell. Alternatively, the use of 1:1 PE-conjugated mAb under the assumption that CD4+ lymphocytes reproducibly bind 50,000 CD4 mAb molecules was proposed to convert units of relative fluorescence intensity into units of antibodies bound per cell. The use of antibody-binding capacity as a surrogate marker for quantification of Ag expression was addressed more directly by the development of antibody-binding standards. The quantitative indirect immunofluorescence assay is based on beads labeled with various amounts of CD5 mAb that calibrate the binding of the secondary antibody in units of antibody-binding capacity. Alternatively, goat anti-mouse-labeled calibration beads have been developed. Published results obtained with the latter calibrators showed an unexpected inaccuracy. The different ways in which calibrators and cells under study bind mAb (i.e., Fab mediated versus Fc mediated) may have contributed to this variation. Recently, the use of stabilized cell populations expressing Ag in a specified range of concentrations has been proposed as an Ag-specific calibration system of mAb binding. We identify several issues on the level of instrumentation, reagents, and cells under study that should be solved to allow standardization of quantitative assessments of immunofluorescence intensity.

Animals↗
PubMedDate not supplied

Organ donation: attitude and knowledge of nurses in South Africa.

Various factors influence the process of organ donation. As a result, there is a shortage of organs for transplant. Poor communication and cooperation between transplant coordinators and intensive care nursing staff can lead to the non-referral of potential organ donors, which is detrimental to the process. The purpose of this research was to ascertain the attitude and knowledge of the transplant coordinators and intensive care nursing staff that work in intensive care units during organ donation. Contextual descriptive research was carried out by compiling literature-based questionnaires, one each for the transplant coordinators and intensive care nursing staff, and then analysing responses. The indications are that problem areas exist between the role players in the organ transplant process. Guidelines were drawn up for the improvement of communication and cooperation between them in order to promote organ donation.

Communication↗
PubMed2002

[Modification of clinical classification of heart failure with quantitative evaluation of functional state].

Definite dissociation exists between severity of clinical symptoms of heart failure and degree of cardiac dysfunction. Comparative analysis of existing heart failure classifications reveals low degree of congruence in evaluation of patient's state by different experts. This disagreement is mainly caused by limited number of gradations in NYHA classification and descriptive character of information. That is why supplementation of current classification with quantitative assessment of functional state by means of introduction of precise and easily obtainable statements is required. A modification of 6 min walk test is suggested for this purpose. The paper contains methodology of the test and calculations necessary for assessment of working capacity (in joules) and intensity of work (in watts). Possibility of evaluation of results of cardiovascular surgery is especially stressed.

Disability Evaluation↗
PubMed1998

Work ability of young adults.

This paper reviews the themes related to work ability of young adults. Premature working discapacity causes significant economical and social costs in Finland compared to other Nordic countries and has for that reason been studied most intensively there. Work ability is an interaction of social, environmental and individual factors such as physical fitness, coping skills, social support behaviour and health behaviour. Environmental factors influencing work ability can be concrete, like physical and chemical exposures or more abstract like unemployment. The work ability of ageing people has been studied intensively, while work ability of young adults has not been properly evaluated so far. The worsened economic situation in Finland has meant an excessive work load for those who still have work. At the same time the risk of permanent unemployment is increasing. This polarizationing affects especially the young because they may fail to enter the working life. Also factors related to childhood may affect and even determine work ability in adulthood.

Adolescent↗
PubMed2005

The use of intraservice work per unit of time (IWPUT) and the building block method (BBM) for the calculation of surgical work.

OBJECTIVE: We will review the contribution to the Medicare Fee Schedule (MFS) by the techniques of intensity of work per unit of time (IWPUT), the building block methodology (BBM), and the work accomplished by the American College of Surgeons General Surgery Coding & Reimbursement Committee (GSCRC) in using IWPUT/BBM to detect undervalued surgical procedures and recommend payment increases. SUMMARY BACKGROUND DATA: The MFS has had a major impact on surgeons' income since its introduction in 1992 by the Centers for Medicare and Medicaid (CMS) and additionally has been adopted for use by many commercial insurers. A major component of MFS is physician work, measured as the relative value of work (RVW), which has 2 components: time and intensity. These components are incorporated by: RVW = time x intensity. METHODS: This work formula can be rearranged to give the IWPUT, which has become a powerful tool to calculate the amount of RVW performed by physicians. Most procedures are valued by the total RVW in the global surgical package, which includes pre-, intra-, and postoperative care for a time after surgery. Summing these perioperative components into RVW is called the building block methodology (BBM). RESULTS: Using these techniques, the GSCRC increased the values for 314 surgery procedures during a recent CMS 5-year review, resulting in an increase to general surgeons of roughly 76 million dollars annually. CONCLUSIONS: The use of IWPUT/BBM has been instrumental to correct payment for undervalued surgical procedures. They are powerful methods to measure RVW across specialties and to solve reimbursement, compensation, and practice management problems facing surgeons.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1996

Exercise intensity. An important factor in the etiology of menstrual dysfunction?

UNLABELLED: The objective of this case control study was to compare training activity in female long distance runners with irregular (IR, n = 13) and regular (R, n = 16) menstrual function, especially with regard to exercise intensity. Serum estradiol concentration during the follicular phase was considered normal in the R subjects (31 +/- 6 pg/I). In contrast, the IR runners were clearly hypoestrogenic (11 +/- 1.6 pg/l). The two groups had similar VO2max, anaerobic threshold (AT) and maximal heart frequency (HFmax). In both groups AT was found at 88% of HFmax. The two groups had similar mean race results in half marathons during the previous year. The number of running contests was, however, twice as high in the IR group. A light portable pulse recorder was used to monitor heart rate during 1 week of regular training activity, and during a controlled high intensity work-out. During a week with normal training activity, and equal amount of training at high intensity levels (> 85% HFmax) was performed by the two groups. The amount of training at lower intensities (< 85% HFmax) was, however, more extensive in the group with irregular menstrual function. During the controlled self-administered, high intensity work-out, the amounts of training at and above AT were equal in the two groups. IN CONCLUSION: no difference in extent of high intensity training between long distance runners with regular and irregular menstrual function could be found in the present study group. The IR runners did, however, have significantly more training activity at lower intensity levels, and more frequent race participation.

Anaerobic Threshold↗